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The importance of minor salivary gland biopsy in prediction of lymphoma in Sjögren's syndrome: should we be obtaining more information about prognosis from minor salivary gland samples?
  1. Robert I Fox
  1. Correspondence to Robert I Fox, Rheumatology Clinic, Scripps Memorial Hospital-XIMED Medical Group, Suite #910, 9850 Genesee Avenue, La Jolla, CA 92037, USA; robertfoxmd{at}

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Theander,1 in this issue, provides an important contribution with the article ‘Lymphoid organization in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjögren’s syndrome'. It has been known for many years that ectopic germinal centres are present in minor salivary gland biopsies of a subpopulation of patients with Sjögren's syndrome (SS). The frequency of SS patients with an ectopic germinal centre in the minor salivary gland biopsy has ranged from 10% to 25%.2,,4 Previous studies by Jonsson and his research group have described the clinical and laboratory characteristics of SS patients with ectopic germinal centres in their minor salivery gland biopsies.5,,9 Other groups have also used histology, immunohistology and gene profiling to characterise the ectopic germinal centre in SS.10,,14 In the current paper, the frequency of ectopic germinal centres was somewhat lower than in previous publications. The goal has been to determine the risk of B cells undergoing transition from benign lymphoproliferation to overt malignancy.15

The current study1 extends those studies by emphasising the increased risk of lymphoma in SS patients whose minor salivary gland biopsy contains an ectopic germinal centre. This is not a new concept, because an association between ectopic germinal centre formation and lymphoma development in primary SS was initially proposed in 1999.16 Despite the important prognostic information to be gained from a more detailed analysis of the minor salivary gland biopsy, most rheumatologists in the USA do not obtain biopsies, and oral pathologists do not routinely examine them critically for the presence of ectopic germinal centres. At present, the minor salivary gland biopsy is used …

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